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Long Term Systemic Therapy : Individuals, Couples and Families 1st ed. Edition Arlene Vetere full chapter instant download
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PALGRAVE TEXTS IN COUNSELLING AND PSYCHOTHERAPY
Series Editors: Arlene Vetere · Rudi Dallos
Long Term
Systemic Therapy
Individuals,
Couples and Families
Edited by
Arlene Vetere · Jim Sheehan
Palgrave Texts in Counselling and Psychotherapy
Series Editors
Arlene Vetere
Family Therapy and Systemic Practice
VID Specialized University
Oslo, Norway
Rudi Dallos
Clinical Psychology
Plymouth University
Plymouth, UK
This series introduces readers to the theory and practice of counselling
and psychotherapy across a wide range of topical issues. Ideal for both
trainees and practitioners, the books will appeal to anyone wishing to
use counselling and psychotherapeutic skills and will be particularly rele-
vant to workers in health, education, social work and related settings. The
books in this series emphasise an integrative orientation weaving together
a variety of models including, psychodynamic, attachment, trauma, nar-
rative and systemic ideas. The books are written in an accessible and
readable style with a focus on practice. Each text offers theoretical back-
ground and guidance for practice, with creative use of clinical examples.
Arlene Vetere, Professor of Family Therapy and Systemic Practice at
VID Specialized University, Oslo, Norway.
Rudi Dallos, Emeritus Professor, Dept. of Clinical Psychology, Uni-
versity of Plymouth, UK.
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2020
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of translation, reprinting,
reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical
way, and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt
from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
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herein or for any errors or omissions that may have been made. The publisher remains neutral with
regard to jurisdictional claims in published maps and institutional affiliations.
This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland
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Foreword
v
vi Foreword
military history and had spent the early part of his adult life conforming
to others’ expectations of him. He was lacking in insight and ability to
take responsibility for his own behaviour and emotions. 9 years down the
line he is a sensitive emotionally aware man who has great insight and
ability for self-reflection. He attends currently every 4–6 weeks. When I
first met him I would never have imagined that I would still be seeing
him at all let alone so regularly. I believe that it is the longevity of our
relationship together that has allowed him to be able to do the work
that he has done that has involved his early relationships with his parents
and wider family, the role the military played in shaping his emotional
expression, and his sexuality.
I have had a number of clients that I saw as teenagers that made con-
tact as adults for varying reasons, for example, one client who I saw when
she was aged 15 years and had a psychiatric diagnosis of anorexia ner-
vosa. She sent me the occasional email over the years letting me know
what she was doing. Then following the birth of her first daughter, when
she was in her early thirties, some of her childhood issues resurfaced in
her parenting of her daughter. She was able to work through relational
difficulties she had with her own mother through thinking about herself
as a mother.
In another example, I shall describe a client who I saw when she was
aged 15 years, who had a psychiatric diagnosis of bulimia and depression.
She was struggling with her dream for herself not being what her par-
ents wanted for her, and again, over the years I got the occasional email
telling me about how she was achieving her dream despite her family’s
opposition. Again in her early thirties she had a crisis when her depres-
sion overcame her. She took herself into the jungle, consumed surgical
alcohol and cut her own throat. It was a miracle she was found. When
she came home she made contact and began to rebuild her life, which
ultimately resulted in her developing a new found spirituality and new
career path. In addition to this she dealt with the death of her much
beloved grandmother, who had been her main source of support within
the family, and ran the London Marathon.
The last client I would like to tell you about is a family I first saw 8
years ago when the parents first divorced. There were 2 children, a boy
of 8 years and a daughter of 11 years. The boy still wanted to see his Dad
Foreword vii
but the daughter had found a sexually explicit message from his girlfriend
on his phone and withdrawn completely from him, with the support of
the mother. My task had been to try to re-engage the father and daughter.
The mother eventually moved forward emotionally and actively worked
on supporting her daughter re-engaging with her ex-husband although
at this point the daughter was adamantly refusing all contact. Despite all
our efforts nothing changed. My final intervention was to encourage the
father to maintain a level of communication with the daughter that he
could sustain without getting anything back. With the mother’s support
he began telephoning once a week to talk to her, initially this was on
the house phone and eventually it was on the brothers’ phone. Over the
years he called from time to time to talk and up date me on the no
change; these conversations, for me, were soul destroying as I felt I had
let him down. For 7 years he maintained this until the daughter went to
university at which point he said to his daughter if she wanted him to
continue talking to her she would need to give him her number. She gave
him her number and suggested they text: this was the first time he had
got anything back from her. For the last year they have been engaging
in text conversations. 2 weeks ago the brother was having a pre prom
gathering at home and wanted his Dad there. The father accepted but
cautioned that he did not want to make his daughter feel she could not
be there, so he would stay away. Via the mother the father was told that
the daughter was ok for him to attend. This was the first time he had
seen his daughter in 8 years. She spoke to him and they hugged. When I
received his email update I cried.
These examples may not be conventional therapy examples; however
the common theme is the strong trusting relationship that was devel-
oped between the therapist and client. In the current climate too much
emphasis, I believe is placed on protocols and replicating treatment plans
that can be rolled out to all regardless of whether or not they are a good
fit. The personal and individualised approach that these examples show
are not possible now for most clients in public sector services.
I value a book that acknowledges long term therapy and the relation-
ships formed between client and therapist that are crucial to that therapy
being successful for those involved. This is particularly important in the
field of family therapy where several members of the same family can
viii Foreword
be seen by the same therapist. On more than one occasion I have been
referred to as ‘our family’s’ therapist. This, for me, is the way forward
for families in the same way a family might have a family GP or family
lawyer, they can also have a family therapist.
ix
x Editors’ Introduction
All the contributors are well known in their field and have extensive expe-
rience of writing for publication: Ros Draper; Chip Chimera; Ana Aguir-
regabiria; Helga Hanks; Sarah Houston; T. K. Lang; Paddy Sweeney and
Martin Daly. We too both contribute a chapter each.
The book is divided into four parts of working therapeutically with (a)
couples and families, (b) with individuals, (c) with professional practi-
tioner groups and (d) with family businesses. In preparing our chapters,
some authors have invited their clients, with whom they have worked
together over the longer term to contribute some thoughts about their
experiences of being in such a long lived relationship, for example, the
chapters by Chip Chimera, Ros Draper and Arlene Vetere.
We shall briefly introduce each chapter in relation to how systemic the-
ory is used to understand the relational processes involved in longer term
systemic psychotherapy. Jim Sheehan writes about his work with couples
where one of them is challenged by a lengthy chronic illness. Systemic
theory illuminates the impact of the illness on the person, their partner,
their relationship and their family/social support systems and how their
circumstances and wider relational contexts influence the progression of
the illness. In working with couples over the longer term, Jim explores
how expected and unexpected life events, and the life cycle changes for
the couple and their relationship all benefit from an ongoing therapeutic
relationship where trust and commitment enable either frequent or in-
frequent consultation and therapy as needed. In her chapter on working
with couples and families, Arlene explores how some people simply need
longer to process and resolve unresolved hurts and losses in their relation-
ships. A typical couple therapy might consist of 10–20 meetings, but for
some, as Arlene shows, more time is needed to consolidate and make co-
herent the systemic experiences of healing, forgiveness and repair. The
development of a shared narrative as to how and why the therapy was
helpful often depends on the integration of, and reflection on, all aspects
of intimate experiences and this where the passage of time affords the
opportunity.
There are 3 chapters on working systemically with individuals. Both
Ros and Chip draw on their clients’ reflections—in Ros’ chapter to con-
struct the account, and in Chip’s to weave together her reflections with
that of her client’s. Chip writes of her therapeutic relationship with her
xii Editors’ Introduction
client and their joint challenge to identify and resolve early adaptive
self-protective processes of dissociation, and other unresolved trauma re-
sponses to relational danger, that in adulthood get in the way of de-
veloping trusting and intimate relationships. Ros, in her chapter, uses
a relationally discursive approach to co-construct accounts of the devel-
opment and progression of the therapeutic relationship and therapeutic
changes over time. Neither Ros nor Chip shy away from addressing the
challenges of longer term systemic work with individuals and focus on
processes of healing and repair in the therapeutic alliance. Sarah works
systemically with young people, and although the length of time spent
in the work might be relatively shorter than, say with the adult-focused
work discussed by Chip and Ros in their chapters, nevertheless, Sarah
uses systemic theory to show how subjective time and distressing experi-
ence can seem extended during adolescence, and thus how to assist young
people in navigating bumps in the road of their emotional and relational
development.
There are three chapters on extended group supervision with profes-
sional practitioners. This partly addresses a clear gap in the systemic lit-
erature (Henning 2016) and also offers an opportunity for all four au-
thors to explore what is enabled by the length of time afforded the group
members. Helga writes of how a committed supervision relationship with
peers and supervisors in a group setting enables the development of in-
terpersonal trust such that deeper recesses of experience can be accessed
and processed in the group with the group members. Her emphasis on
self care and care of others in extremely challenging working contexts
shows us all how persistence and emphasis on small acts of care and kind-
ness can systemically reverberate throughout the wider working system.
Similarly TK and Paddy and Martin in their systemic group work with
pastoral care teams and health care providers explore and illuminate the
development of processes of trust and trusting behaviour that enables
and sustains professional receptivity and complex emotional risk-taking
in their day-to-day work. All three chapters explore the parallel processes
and emotional dynamics in group work that can mirror similar processes
in the workplace and in other walks of life.
Editors’ Introduction xiii
References
Carr, A. (2014a). The evidence base for family therapy and systemic interven-
tions with child-focused problems. Journal of Family Therapy, 36, 107–157.
Carr, A. (2014b). The evidence base for couple therapy, family therapy and sys-
temic interventions with adult-focused problems. Journal of Family Therapy,
36, 158–194.
Henning, M. (2016). Positive dynamics: A systemic narrative approach to facili-
tating groups. London: Palgrave Macmillan.
Contents
xv
xvi Contents
Index 201
Notes on Contributors
xvii
xviii Notes on Contributors
In recent years she has also specialised in working with trauma organ-
ised systems, particularly those families who have engaged in prolonged
custody disputes.
Martin Daly is also a Catholic priest, family therapist and systemic
practitioner. He trained at the Mater Hospital Family Therapy Training
Programme. Until recently he has been Principal at a large Dublin sec-
ondary school. He has a particular interest in systems based leadership
in educational and other settings and has completed doctoral studies in
Leadership and Management. He practices as a family therapist and as a
consultant to groups and organisations.
Ros Draper is a systemic psychotherapist, supervisor and consultant
with many years experience working in the public sector and in private
practice. With David Campbell, Ros co-founded the influential Systemic
Thinking and Practice book series and has co-authored with Rudi Dallos
An Introduction to Family Therapy now in its 4th edition. Ros is passion-
ate about the usefulness of systemic ideas and the distinctive difference
these ideas make to the practice of psychotherapy.
Helga Hanks practiced as a Consultant Clinical Psychologist, Analytic
Psychotherapist and Systemic Family Therapist, in St James’s University
Hospital, Leeds. Until her retirement from her fulltime post she was also
a Visiting Senior Lecturer at the Institute of Psychological Sciences, Leeds
University. She is one of the founder members of the Leeds Family Ther-
apy & Research Centre (LFTRC) at Leeds University which came into
existence in 1979. She has been Clinical Director of the Centre until
2005. She is one of the core staff who developed the M.Sc. in Systemic
Family Therapy at the Institute of Psychological Sciences, Leeds Univer-
sity. Since 2001 she has worked in the Community Paediatric Depart-
ment, Leeds Community Healthcare NHS Trust. There she worked with
NHS staff supporting them emotionally and psychologically. Since 1980
she has provided systemic training and supervision for a wide variety of
professionals. She retired in 2019. The Journal of Human Systems was
first published in 1990 and she was a founder Member of that Journal.
She continues to be on the Editorial Board and has since 2017 been joint
Notes on Contributors xix
editor of the Journal. She has published and researched widely both in
the areas of family therapy and child abuse.
Sarah Houston is systemic psychotherapist working in Childrens’
Health Ireland at Our Lady’s Children’s Hospital Crumlin, in Dublin.
She works in a specialist therapy service for children and adolescents who
have experienced sexual abuse, and their families. She also works in pri-
vate practice as a systemic psychotherapist and supervisor. She has a back-
ground in social work and has been working in the area of mental health
for 20 years, much of which has involved working with children, young
people and families in Child and Adolescent Mental Health Services. She
has many years’ experience teaching on social work and family therapy
programmes at undergraduate and masters level. She lives in Dublin.
T. K. Lang, Dr. Theol. is Associate Professor in Theology at The Uni-
versity of Oslo. He works as Family Therapist and Supervisor, and has
for more than 35 years been supervisor for ministers, family therapists,
social workers, physicians, and other professionals. For many years one of
the editors of “Omsorg: Nordisk tidsskrift for Palliativ Medisin” (Nordic
Journal of Palliative Medicine). He is the co-author of Der fremtiden blir
til: Et dialogisk paradigme for veiledning (Where the Future is Formed: A
Dialogic Paradigme for Supervision). He has been in private practice as a
family therapist since 1989.
Jim Sheehan, Ph.D. is professor of family therapy and systemic prac-
tice at VID Specialized University, Oslo. He is a social worker, systemic
psychotherapist and systemic supervisor, practising and resident in Ire-
land. With Arlene Vetere he co-edited Supervision of Family Therapy and
Systemic Practice for Springer, 2018.
Paddy Sweeney is a Catholic priest, a family therapist and systemic
practitioner. Trained at the Mater Hospital, Family Therapy Training
Programme in Dublin and at the Tavistock Clinic in London he cur-
rently holds responsibility for the well being of clergy and church work-
ers in Dublin. This responsibility is enacted through one to one work
with individuals, the Ministering Reflectively programme, consulting to
groups and offering training.
xx Notes on Contributors
But today, he went too far, and when the silence grew
unbearable she said impetuously, "Do say something, Vinzi!
It is just as though you were not here at all."
That evening after the children had gone to bed and the
parents were sitting alone, the father said he had gone to
town to talk with his friend, but found he had left that
morning to drive his cattle over the mountain. But there
was nothing unfortunate in that; on the contrary. He had
been informed that a young workman from Gondo was
returning to that town on Monday and as he would make
the way from Brig by foot, would have to put up somewhere
over night. That would be better for Vinzi; he would not
have to walk all the way. They would stay over night at
Berisal, where an innkeeper Mr. Lesa knew would give them
good accommodation.
"He knows. I told him early this morning. All you have
to do is to tell him when," said the mother.
CHAPTER IV
A DEPARTURE AND AN ARRIVAL
The father did not doubt for a moment that there was
some new reason for his daughter's sudden enthusiasm
about music. But that was not the main issue. He felt some
reparation must be made to the boy who had been kind
enough to return his daughter's scarf and afterward been
offered insult when he came to see her on her invitation. He
would call on the boy and his parents and apologize at
least, perhaps even make the boy some little present. Much
delighted, Alida took the place of guide, for she had learned
from Vinzi where he lived.
"I think that belongs to the bad side," said Alida quickly.
"The heavy needles will hurt your hands and the thick yarn
has cut your forefinger already. Come along out to the
barnyard. I hear the hens cackling out there."
"That is not for Vinzi," she said calmly. "His father would
never allow his only son to leave home for years and years
to study music and then gain an uncertain living among
strangers."
"It is queer how things go in this world," remarked Mr.
Thornau. "Look at that youngster out there! He is my only
son, but if he would express a wish, I would give him
anything. If he wished to study, I would be the happiest of
men. But what do you think? If I say, 'My son, would you
like to learn to ride?' he answers, 'No, I'd rather not.' If I
ask him, 'Would you like to learn to play the violin, the
flute?' he says, 'No, I'd rather not.' 'Would you like to be a
sailor and cross the seas to foreign lands?' 'Oh, no, I'd
rather not!' And so it goes with every question. And so I
must look with envy at your son who has a decided desire
in his heart."
"Then why don't you let him stay with her?" inquired
Mrs. Lesa earnestly.
"Yes, sir."
"Yes, Vinzi has gone away for the whole summer, and
mother doesn't know the people he is with," Stefeli
informed him.
When Stefeli had gone that far in her story, the door
opened and her mother entered. Mr. Delrick explained that
he had come to her at her husband's suggestion, but he
was not sure he ought to bother her now as he had just
learned from her daughter that they were having some
sorrow.
His wife told him she had been unable to give any
definite answer without knowing what he thought about the
matter. "But, Vinzenz, I believe that if the gentleman comes
to stay with us, he will bring us a blessing," she concluded.
CHAPTER V
IN EXILE
VINZI made the first half of his journey without
speaking a word. The thought that he was to live with
strangers a long time depressed him, so he did not wish to
talk and scarce realized what went on around him.
It was all the same to Vinzi whether the halt was long
or short, and he had no desire for food. He thought only of
his arrival at the house which might be as dismal as this
one of gray stone. And then those strangers! Now they
reached the summit and the road began to descend.